=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023360161
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MILESTONES BEHAVIOR CONSULTING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2012
-----------------------------------------------------
Last Update Date | 10/14/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3981 KYLE LN
-----------------------------------------------------
City | VESTAVIA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35243-5633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-610-9616
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3981 KYLE LN
-----------------------------------------------------
City | VESTAVIA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35243-5633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CONSULTANT
-----------------------------------------------------
Name | ASHLIE L GRILL
-----------------------------------------------------
Credential | BCBA
-----------------------------------------------------
Telephone | 205-610-9616
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------